He presented with fever, shortness of breath and a purpuric rash. Radiological investigations allowed the diagnosis of severe nodular pneumonia. [ncbi.nlm.nih.gov]

and ( iii ) whether malnutrition influences the dermatological presentation of measles. [samj.org.za]

Case Presentation: A healthy 54-year-old Asian female presented with 7 days of fever accompanied by a rash that spread from her neck and face to the entire trunk and extremities for the past 5 days. [shmabstracts.com]

Clinical Presentation Symptoms and signs Measles classically presents with a high fever (often >104°F [40°C]), generally of 4–7 days in duration. [westjem.com]

• Fever

  The most common admitting diagnoses were varicella, scarlet fever, meningococcemia, and Rocky Mountain spotted fever, due largely to the protean cutaneous manifestations. Roentgenographic studies showed diffuse, segmental, and nodular chest lesions. [ncbi.nlm.nih.gov]

  Pneumonia is common … Medical dictionary AMS (atypical measles syndrome) — An altered expression of measles, AMS begins suddenly with high fever, headache, cough, and abdominal pain. [medicine.academic.ru]

  Clinical findings High fever, headache, cough, abdominal pain, followed by rash 1 to 2 days later, often beginning on the limbs, acral oedema; pneumonia is common and may persist for 3 months or more. [medical-dictionary.thefreedictionary.com]

  Atypical measles syndrome (AMS): An altered expression of measles, AMS begins suddenly with high fever, headache, cough, and abdominal pain. The rash may appear 1 to 2 days later, often beginning on the limbs. [medicinenet.com]

• Malaise

  Prodromal symptoms of fever, malaise, myalgia, headache, nausea, and vomiting were commonly followed by coryza, sore throat, conjunctivitis, photophobia, nonproductive cough, and pleuritic pain. [ncbi.nlm.nih.gov]

  Three patients, referred to as having severe systemic reactions by Krause et al, 2 experienced fever to 103 F (39.4 C), malaise, marked local pain, swelling and erythema seven days following vaccination; these reactions lasted an average of eight days [pedsinreview.aappublications.org]

  Measles has an incubation period of approximately 8 to 12 days, which is followed by a prodromal phase of high fever, cough, coryza, conjunctivitis, and malaise. [mayomedicallaboratories.com]

  Prodromal period:  3-4 days  Non-specific symptoms: fever, malaise, anorexia, headache  Classical triad: cough, coryza, conjunctivitis (with photophobia, lacrimation) 8. [slideshare.net]

• Localized Pain

  Three patients, referred to as having severe systemic reactions by Krause et al, 2 experienced fever to 103 F (39.4 C), malaise, marked local pain, swelling and erythema seven days following vaccination; these reactions lasted an average of eight days [pedsinreview.aappublications.org]

• Cardiomegaly

  A chest roentgenogram disclosed cardiomegaly and small nodular shadows throughout the chest. Non-specific ST segment changes were noted on an electrocardiogram. [jstage.jst.go.jp]

• Skin Rash

  The main symptom of measles is an itchy skin rash. The rash often starts on the head and moves down the body. Other symptoms include fever cough runny nose conjunctivitis (pink eye) sometimes measles can lead to serious problems. [icd10data.com]

  DIAGNOSIS characteristic clinical picture: Measles contact Koplik spot Features of the skin rash The relation between the eruption and fever Laboratory confirmation is rarely needed 28. [slideshare.net]

  Williams & Wilkins, Baltimore London, p 55 Google Scholar Sherkov L (1980) Pulmonary residuum 14 months after skin rash and pneumonia. [link.springer.com]

  As the rash begins to fade, there will often be a fine flaking of the skin ( desquamation ). The rash fades in the same order that it appears. The fever that occurs with measles is called a stepwise fever. [rxlist.com]

Complicated and possibly hazardous workups can be avoided by awareness of this disease. [ncbi.nlm.nih.gov]

• Multiple Pulmonary Nodules

  Pediatrics 50:712 PubMed Google Scholar Chun PKC (1978) Multiple pulmonary nodules in a young man. Chest 73:527–528 PubMed CrossRef Google Scholar Carlo J De jr, Startzman HH jr (1954) The roentgen study of the chest in measles. [link.springer.com]

We used the following outcomes to measure recovery: fast improvement ‐ the fever had abated within 48 hours following treatment; and marked improvement ‐ meaning the fever had abated within three to five days after treatment. [cochranelibrary.com]

Treatment Unfortunately, there is no cure for measles. [verywell.com]

[…] and Therapy Treatment is supportive, focusing on relieving common symptoms and providing nutritional support, including vitamin A supplementation. [jucm.com]

Treatment is mainly supportive, but children should also receive vitamin A supplementation. [merckmanuals.com]

Reverse transcription-polymerase chain reaction testing can also detect measles virus in the blood and urine when direct evidence of the virus is necessary, such as in immunocompromised patients. 29 TREATMENT IS SUPPORTIVE Treatment of measles mainly [mdedge.com]

What is the prognosis for measles? Most people who contract measles will recover completely. Very few people who get measles will die. People who are malnourished or immunocompromised are more likely to have complications or die. [rxlist.com]

The etiology of the measles infection in our vaccinated patient is not determined, yet the most plausible explanation is vaccine failure. [shmabstracts.com]

ETIOLOGY Measles virus An RNA virus of the genus Morbillivirus in the family of Paramyxoviridae One serotype, human’s only host Stable antigenicity Rapidly inactivated by heat and light Survival in low temperature. 4. [slideshare.net]

Consequently, pneumonia, whether due to the measles virus itself, to tuberculosis, to or another bacterial etiology, is the most frequent complication. [emedicine.medscape.com]

Cozen W, Hamilton AS, Zhao P, Salam MT, Deapen DM, et al. (2009) A protective role for early oral exposures in the etiology of young adult Hodgkin lymphoma. Blood 114: 4014-4020. [omicsonline.org]

An earlier, landmark study in the American Journal of Epidemiolog y by the Center for Disease Control’s Roger Barkin found similar disturbing results of measles’ toll on the disadvantaged. [financialpost.com]

EPIDEMIOLOGY Infection sources  Patients of acute stage and viral carriers of atypical measles Transmission  Highly contagious, approximately 90% of susceptible contacts acquire the disease.  Respiratory secretions: maximal dissemination of virus occurs [slideshare.net]

"Explosive School-based Measles Outbreak Intense Exposure May Have Resulted in High Risk, Even Among Revaccinees," Mikko Paunio (Department of Public Health, Helsinki University, published in the American Journal of Epidemiology,1998. 4. [vaclib.org]

EPIDEMIOLOGY : Before vaccine introduction in 1963 in United States, 130 million cases and 7-8 million deaths were estimated to be due to measles and 95-98% of children were infected Footnote 4 Footnote 6. [canada.ca]

Langmuir, MD, " Epidemiologic Basis for Eradication of Measles in 1967 ," Public Health Reports, vol. 82, no. 3, March 1967, p. 256. 16. [greenmedinfo.com]

[…] settings where the test may be helpful Determining acute-phase infection with rubeola (measles) virus using IgM antibody testing Aiding in the identification of nonimmune individuals through IgM antibody testing Clinical Information Discusses physiology, pathophysiology [mayomedicallaboratories.com]

Measles, a vaccine-preventable disease, is currently responsible for worldwide outbreaks mainly due to the failure to maintain high coverage of childhood immunisation. [ncbi.nlm.nih.gov]

Physicians should be aware of the atypical measles syndrome presentation in order to limit the delay of diagnosis, to avoid unnecessary investigations and to prevent the potential spread of this infectious disease. [casereports.bmj.com]

Bibliography Centers for Disease Control and Prevention. Frequently asked questions about measles in the U.S. Atlanta, GA: Centers for Disease Control and Prevention [cited February 10, 2015; last updated February 3, 2015]. [jucm.com]

It is effectively preventable with MMR (measles, mumps, and rubella) vaccine. The etiology of the measles infection in our vaccinated patient is not determined, yet the most plausible explanation is vaccine failure. [shmabstracts.com]